Registration Form - Randonnee Aventure

Randonnée(Aventure(!(Registration(!(Spring(2016
514935996781( !!www.randonnee.ca(
(
You(can(also(register(and(pay(on(our(website((
Please mark if:
Please print clearly
First name: _______________________ Last name: _____________________________
"
"
Address: __________________________________________________ Apt: _________
City: ___________________________Prov: __________ Postal Code: ______________
New member
Some information has
changed
Phone: Home _____-_____-________ Work _____-_____-__________ ext. ________
Cell: _____-_____-________
E-mail: __________________________________________________
25!
I agree to receive confirmation and information from Randonnée Aventure by email
Emergency contact: Name_____________________________________________________Tel:__________________________
Important - Randonnée Aventure Needs Your Help!
Our success depends on the efforts of our membership. Please mark the area(s) that you would like to help out with:
Ski & Snowshoeing
Cycling
4! Hiking
8! Social Activities
! Website maintenance
Long Weekends
19 ! Translation
1!
3!
! Club Administration & Management
Telephone calling, messages, etc.
20! Marketing, Publicity & Advertising
24! No preference, but I am willing to help
7
9
11!
10!
Annual Membership Fee: $20
= $____________
Please verify membership expiry date on mailing label.
• Before registering, check which trips are sold out at the Club
website: www.randonnee.ca.
Cycling Day Trips
No registration is required for Saturday carpool or meet-and-ride
trips. See the Club website for full trip list, prices
and meeting locations.
Please mark your choices clearly with an X.
May 14
May 28
June 11
June 18
July 09
July 23
Aug. 06
Aug. 13
Aug. 20
Sept. 10
Sept. 17
Sept. 24
Oct. 01
Oct. 15
Oct. 22
Sat.
Sat.
Sat.
Sat.
Sat.
Sat.
Sat.
Sat.
Sat.
Sat.
Sat.
Sat.
Sat.
Sat.
Sat.
• After registering you cannot switch trips. However, the Club
offers a buy/sell procedure.
• Potential members may buy 1 day trip before joining the Club.
Hiking Day Trips
1
! 2
! 3
! 4
! 5
! 6
! 7
! 8
! 9
! 10
! 11
! 12
! 13
! 14
! 15
• To save on all bus trips, pay by May 16 for the Early Bird
discount. Trips after August 1 may be booked at the lower price
with a cheque postdated to August 1, if the cheque is received
before May 16.
• Confirmation of your trip registrations will be sent to you.
Mont St-Hilaire, QC (Meet & Hike, no registration required. See website for details)
Les Contreforts, Notre-Dame-de-la-Merci, QC
Hurricane Mtn, Keene Valley, NY, USA*
*Important: For trips to the USA, bring your
Matawinie, Ste-Émélie-de-l’Énergie, QC
required
documents.
If you
notrequired
a Canadian
*Important:
For trips
to the US,
bringare
your
Big Slide, Brothers, Keene Valley, NY, USA*
or IfUS
citizen,
youa may
need to
documents.
you
are not
Canadian
or be
USfingerprinted
citizen,
Montagne Noire, Val-des-Lacs, QC
and photographed
whenand
crossing
the border.
you may need
to be fingerprinted
photographed
Grande Vallée, Chertsey, QC
when crossing the border.
Noonmark & Round, Keene Valley, NY, USA*
Mt. Ouareau, Kaaikop, Ste-Lucie-des-Laurentides, QC
Mystery Hike, QC
ADK Loj, Lake Placid, NY, USA* (Extended)
Mt Mégantic, Notre-Dame-des-Bois, QC
Mt Mansfield W, Underhill Center, VT, USA* (Extended)
Parc de la Mauricie, St-Jean-des-Piles, QC
Belvidere Mtn, Montgomery Center, VT, USA*
!
Trips 2 - 15: ______ x $34 per trip ($40 for cheques dated or received after Monday, May 16).
Early Bird Price:
$34 per trip
- Cheques must be received by Monday, May 16. (Trips after Aug.1 may be paid with
a cheque postdated to Aug.1.) On-line payment must be made by May 16.
Pre-paid Price:
$40 per trip
- Payment by mail must be received by the Club two weeks before the trip.
- On-line payment must be made before 9 pm on the Wednesday prior to the trip.
On-Bus Price:
$45 per trip
- Trips paid for on the bus do not benefit from the above discounted pricing.
= $ _________
Subtotal (including membership fee)
Trail Maintenance – I am interested in participating.
New York:
74 !
Sept. 16-18
$ __________
((Randonnée(Aventure(!(Registration(!(Spring(2016((((page(2
Subtotal carried from other side
= $ _________
Weekend Getaways (Carpool)
•
•
•
•
See the Club website for complete details about weekend trips.
Space is limited and registration is first come, first served.
Weekend trips are non-refundable. However, there is a buy/sell procedure. See the Club website for details.
Non-members, please complete the membership section on the other side and include $20 membership fee.
Victoria Day Cycling Weekend, Friday, May 20 – Monday, May 23 – Picton, Ontario
! $260 (payment must be received by May 2) - Carpool fee $70 payable to driver
! I have a car for carpooling
I have a bike rack
5 !
I would like to share a room with _____________________________________ (optional)
8 !
50
$ __________
4
St-Jean-Baptiste Hiking/Cycling Weekend, Thurs, June 23 – Sun, June 26 – Loon Mtn, Lincoln, NH, USA
51!
I plan to:
2!
!
!
8!
4
5
$216 (payment must be received by May 16) - Carpool fee $60 payable to driver
Cycle
3 ! Hike
I have a car for carpooling
I have a bike rack
I would like to share a room with _____________________________________ (optional)
$ __________
Labour Day Weekend, Fri, Sept 2 – Mon, Sept 5 – Massif du Sud, QC (Hiking) 52!, Shawinigan, QC (Cycling) 53!
Details to be announced
Thanksgiving Hiking Weekend, Friday, Oct 7 - Monday, Oct 10 – Waterville Valley, NH, USA 57!
Details to be announced
Weekender Cycling Trips (Carpool)
Friday, July 15 – Sunday, July 17 (2 nights) – Lévis / Île d’Orléans, Quebec
54 !
4!
5!
8!
$195 (payment must be received by June 13) – Carpool fee $50 payable to driver
I have a car for carpooling
I have a bike rack
I would like to share a room with______________________________________(optional)
$ ___________
Friday, August 12 – Sunday, August 14 (2 nights) – Nominingue, Quebec
55 !
4!
5
!
8!
$185 (payment must be received by July 11 Carpool fee $35 (+$10 for Mt Laurier option) payable to driver
I have a car for carpooling
I have a bike rack
I would like to share a room with_____________________________________ (optional)
$ ___________
Total for all purchases (make cheque payable to Randonnée Aventure): $ ___________
Please complete and sign the waiver below.
WAIVER
TO: RANDONNÉE AVENTURE (the "Club")
I understand that the Club is a not for profit corporation managed by non-professional volunteers,
that the objects of the Club are, among other things, to facilitate participation by members in
wilderness and other recreational activities and that participation in such activities involves
significant risk of bodily injury or death. I understand that none of the Club, its members,
directors, officers, servants, agents or other representatives (collectively, the “Club Organizers")
has any expertise in connection with such activities and that I am solely responsible for
determining my ability to participate in such activities.
In consideration of being permitted to participate in activities organized by the Club, I agree that
my participation, and that of any minors accompanying me in such activities, shall be entirely at
my own risk, and upon my own responsibility.
Furthermore, I agree that if my privilege of participation in a Club activity is transferred to another
person, in any form whatsoever, or if I purchase an activity for another person, I will ensure that
the person actually participating will provide the Club with a duly completed waiver of
responsibility prior to the start of the activity and that, if such a waiver is not provided to the Club,
I will indemnify and hold the Club and the Club Organizers harmless from and against all liability,
loss, cost or damage arising out of, or in connection with, the participation of that person in the
activity in question.
I hereby assume, to the complete exoneration of the Club and the Club Organizers all risks of
such participation, including travel. I hereby renounce all claims and rights of action, present and
future, of whatsoever nature against the Club and the Club Organizers in respect of loss, cost or
damage (including, without limitation, bodily injury or death and damage to or loss of property)
arising out of or in connection with my participation in such activities, whether or not such loss,
cost or damage is caused by the fault of the Club or the Club Organizers and I hereby forever
release and discharge the Club and the Club Organizers therefrom and agree to indemnify and
hold the Club and the Club Organizers harmless from and against all liability, loss, cost or
damage arising out of or in connection with such participation.
I confirm that I have requested an English language version of this document, a French language
version being available.
Dated this ______ day of _____________________ 2016
Veuillez compléter et signer le dégagement ci-dessous.
DÉGAGEMENT
A: RANDONNÉE AVENTURE (le Club)
Je reconnais que le Club est une corporation à but non lucratif gérée par des volontaires nonprofessionnels, que les buts du Club sont, entre autres, d’aider les membres à participer à des
activités en pleine nature ainsi qu’à d’autres activités récréatives et que cette participation peut
comprendre des risques importants, de blessures corporelles ou de mort. Je reconnais que ni le
Club ni ses membres, administrateurs, dirigeants, préposés, agents ou autres représentants
(appelés collectivement les Organisateurs) ne possèdent d’expertise relative aux dites activités
et que je suis seul(e) responsable de déterminer ma capacité d’y participer.
En considération de mon acceptation comme membre du Club, ou que la permission me soit
accordée de participer aux activités organisées par le Club, je conviens par la présente que ma
participation, et celle de toute personne mineure qui m’accompagnerait aux dites activités, sera
ma responsabilité.
En outre, je conviens que si je cède ma participation à une activité du Club à une autre
personne, de quelque forme que ce soit, ou si j’achète une participation à une activité pour une
autre personne, il est de ma responsabilité de m’assurer que cette personne fournisse au Club
un dégagement de responsabilité dûment rempli, avant le début de l’activité et que, si ledit
dégagement n’est pas fourni, je garantis le Club contre toute responsabilité, perte ou dommages
découlant de, ou en rapport avec, la participation de cette personne à l’activité en question.
J’accepte par la présente, à la libération complète du Club et des Organisateurs, tout risque
d’une telle participation, y compris tout risque relié au transport, je renonce par la présente à
toute réclamation et droit d’action, présent et futur, de quelque nature que ce soit contre le Club
et les Organisateurs concernant la perte ou les dommages (y compris, sans limitation, les
blessures corporelles ou la mort et les dommages à mes biens ou la perte de ces derniers)
provenant de, ou relative à ma participation aux dites activités, même s’ils sont dus à la
négligence du Club ou des Organisateurs et je donne par la présente quittance complète et
finale au Club et aux Organisateurs et conviens de les tenir indemnes de toute responsabilité,
perte ou dommage provenant de, ou relative à une telle participation.
Daté ce ______ ième jour de _________________ 2016
Signature:
Signature:
Prénom, nom:
Name:
(Please Print)
(Lettres moulées)
Mail this form and all cheques to: RANDONNÉE AVENTURE PO BOX 26541 RPO QUEEN MARY MONTREAL QC H3X 4B1